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The Annals of Thoracic Surgery, Vol 57, 1402-1407, Copyright © 1994 by The Society of Thoracic Surgeons
GD Dreyfus, D Duboc, A Blasco, F Vigoni, C Dubois, D Brodaty, P de Lentdecker, J Bachet, B Goudot and D Guilmet
Patients with ischemic heart disease, congestive heart failure, and low
ejection fraction are usually referred for orthotopic heart
transplantation. Based on results of myocardial viability assessment, we
have prospectively used either coronary artery bypass grafting or
orthotopic heart transplantation. From January 1990 to June 1992, among 50
patients initially referred for heart transplantation, 46 showing
myocardial viability underwent bypass grafting. Forty-five of these 46
patients were men, and the mean age was 58 +/- 12 years (range, 40 to 70
years). Congestive heart failure was present in all patients, and dyspnea
was the main symptom in 80% (37/46). Patients were selected according to
three criteria. (1) Myocardial viability was primarily assessed by thallium
scintigraphy for up to 24 hours (28/46 patients). When results were
negative, patients underwent positron emission tomography (20/46 patients).
(2) Regional left ventricular function was assessed using gated blood pool
single-photon emission computed tomography combined with (3) full
hemodynamic evaluation. Results were as follows: end-diastolic volume, 129
+/- 35 mL/m2; ejection fraction, 0.23 +/- 0.06; cardiac index, 2.4 +/- 0.62
L.min-1.m-2; mean pulmonary artery pressure, 26 +/- 0.90 mm Hg; and mean
pulmonary capillary wedge pressure, 16 +/- 1.10 mm Hg. Operative mortality
was 2.17% (1/46). During follow-up (mean duration, 18 months), there were
three late cardiac-related deaths (arrhythmias) and two noncardiac-related
deaths. The 40 long-term survivors are in New York Heart Association class
II. Angiography (15 patients) or gated blood pool single photon emission
tomography (32) showed improvement in mean ejection fraction to 0.39 +/-
0.13 (range, 0.22 to 0.46).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Myocardial viability assessment in ischemic cardiomyopathy: benefits of coronary revascularization
Department of Cardio-Vascular Surgery and Transplantation, Hopital Foch, Paris V University, Suresnes, France.
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